Pica, Rumination, and Other “Behaviors” 1

I don’t remember noticing pica (eating inedible objects) when Robert was a toddler.  It might be that  my  memory decided to ignore that fact. It might be that I simply didn’t notice pica as I was overwhelmed with many piling problems. But it also might be that this behavior  was not present yet.  I noticed this disorder when Robert was almost five.  Robert knew that he was not supposed to put inedible objects into his mouth so he tried to hide this habit and mostly succeeded.   I remember one of his teachers from ABA program telling me that she worked with Robert while the other teacher was observing and yet they both missed the moment when Robert put a piece of a crayon in his mouth.  By the time he was ten years old, Robert’s ability to conceal his habits became uncanny. At home I had not noticed Robert even touching winter insulation of windows and doors. I saw him looking through windows, nothing else. I became  suspicious when I found out that  many parts of the insulation were missing.   I could sit next to Robert on a sofa watching TV with him and  not notice that he was pulling fluffy stuff from the sofa’s pillow through a little hole along the seam and placing this cotton like substance in his mouth. Whenever I turned to him he was watching TV completely engrossed in the movie.  I finally connected thinning pillow and missing insulation to Robert’s pica and bouts of aggressions, self injurious behaviors, and very dramatic screaming.  I removed the insulation, I replaced the old sofa and the frequency and severity of those behaviors decreased dramatically.  But not completely.

There was another substance to blame:  silly putty.

Robert loved silly putty, craved silly putty, played with silly putty, and …ate silly putty. Silly putty seemed to be a great reinforcer.  Robert would do everything for it, read, write, count, and follow directions.  Moreover,he was playing very appropriately.  He  rolled, squeezed, and stretched.  So his teachers and I were not able to write such powerful  reinforcer off.  We  thought that we would just keep it under strict  control, limiting Robert’s access to it and observing him very closely.

We were deceiving ourselves.

We were no match for Robert’s ability to sneak any gooey substance into his mouth and then stomach.  We paid for our weak resolve by witnessing Robert in distress. He was in pain and we couldn’t do anything then about it.  Only when I decisively removed all silly putty, rubber balls, soft plastic materials from the house, Robert’s behavior improved significantly.

I wonder if constant reinforcing with candies, chips and juice didn’t contribute to this condition.  Constant reinforcing meant that there was something almost always in Robert’s mouth.  He might have gotten used to that feeling and craved it.  I knew that this schedule of reinforcing was not good for Robert’s teeth, but did it also aggravate or cause his pica?  

I also wonder why I didn’t know then that pica was often associated with iron deficiency.  From pediatricians to psychologists everybody assumed that pica is one of the autism related behaviors, so nobody suggested that I check Robert’s iron level.

And I didn’t.

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